Applied Behaviour Analysis

An early learning intervention system

Autism is Amenable to Change

Unfortunately, we do not know what causes autism. While autism is almost certainly a neurological disorder, the evidence shows that it is amenable to change. Extensive research has shown that children with autism do not learn readily from typical environments, but can learn a great deal given appropriate instruction. Intensive early intervention based on the principles of Applied Behaviour Analysis (ABA) can produce significant and lasting changes in the lives of a large proportion of children with this developmental disorder. It can amount to normal intellectual, social, academic, communicative and adaptive functioning for some. We also know that it often leads to successful integration in mainstream schools. The vast majority of children make significant developmental gains, even if they don't reach 'normal' functioning.

When to Start an Early Intervention programme

The best outcomes can be expected for those children accessing intervention early, preferably prior to 3 years of age. There seems to be a period of time in which the young brain is particularly amenable to change. The intensity of the intervention programme and the length of time the children participate also seems to be related to best outcomes. Certainly, no other treatment for autism offers comparable evidence of effectiveness.

Autistic children perform stereotypic behaviors such as rocking or twiddling a penny because engaging in repetitive behaviors shuts off sounds and sights which cause confusion and/or pain. The problems is that if the child is allowed to shut out the world, his brain will not develop. Autistic and PDD children need many hours of structured education to keep their brain engaged with the world. They need to be kept interacting in a meaningful way with an adult or another child. The worst things for a young two to five year old autistic child is to sit alone watching TV or playing video games all day. His brain will be shut off from the world. Autistic children need to be kept engaged; but at the same time, a teacher must be careful to avoid sensory overload.

ABA Methods

ABA employs methods based on scientific principles of behaviour. In an early intervention programme for children with autism, ABA involves complex skills being broken down into small, teachable components. These components are taught in a highly structured and hierarchical manner. The parent, carer, therapist or teacher learns how to systematically reward or reinforce desired behaviours (e.g., language) and ignore, redirect or discourage inappropriate behaviours (e.g., repetitive play, self stimulation). Another essential component is the careful monitoring of teaching goals and strategies. The child's programme is written in such a way as to keep an accurate record of teaching objectives and achievements so it can be monitored and modified as required. Teaching strategies are also monitored and modified as required. Intervention programmes are highly individualized. The skills and deficits of an individual child are carefully analysed. It is also important to note that the methods of ABA with children with autism continue to evolve as new evidence emerges.

Learning to Learn

The aim is for a child with autism to 'learn to learn' as typical children do. For example, typical children imitate adults and other children as a means of learning an enormous range of behaviours including language, play and social skills. Children with autism tend not to do this. Therefore, an early intervention programme based on the principles of ABA teaches a child with autism who is unable to imitate, to first imitate simple motor movements and later finer motor movements, sounds, and play behaviour. The aim is to teach the child that 'imitating what someone else does is good', so that he or she will then imitate and learn from others in a natural context as typical children do. To illustrate this using a different example, children with autism often do not often display a desire to please, or to put it another way, they do not find adult praise rewarding in the way typical children do. So, teaching a child with autism that 'praise from others is good' is not only a critical social concept but also allows us to use praise and acknowledgment to teach many skills.

A personal perspective (Sandy Winning)

I feel ABA is the best option because it is the only method that has been proven scientifically to have the best effect when working with children with autism. Princeton University in America has a school for children with autism and have been using this method for the last 20 years and 65 - 70% of their students leave indistinguishable from their peers. I have seen with my own eyes children that have been through an ABA programme and children that haven't. If I had another child tomorrow diagnosed with autism there is no doubt in my mind that I would launch into an ABA programme the day I found out.

Some parents find running an ABA programme too hard as it is a huge commitment - when my son was doing his I worked at it all day and night for the 4 years - no holidays, no life it is as simple as that. I took it to the extreme because I wanted recovery and to give it my best shot. Some people do a mixture but it is hard work or financially impossible for some families and mentally draining for most. Some families do as many hours a week as they can afford or the child can tolerate - there isn't really a benchmark, although ideally you want 38 hours per week. It isn't the cost of the 'treatment' so much as the hours needed so it is the staff wages that cost so much.

This is why the cards are so important because on top of all of this the parents have to make all of their own materials because until Winning Connection was designed there wasn't anything specific available for the parents to teach with.

I know some people feel that because ABA is so regimented that it is cruel. I think it is more cruel to leave a child locked inside a body who doesn't know how to express himself and leads a life of frustration and pain at not being understood.

Suggested Reading

Green, G. (1996). Early behavioral intervention for autism. In C. Maurice, G. Green and S.C. Luce (Eds.), Behavioral intervention for young children with autism: a manual for parents and professionals (pp. 29-44). Austin, Texas: Pro-ed.

Home programme Tips

Managing a home programme was a challenging experience to say the least. Below are some tips that I hope will help make your life a little easier

The first step is to find an experienced person in the field of ABA
who can act as your programme manager. When we started our home programme,
there wasn't any funding, but we made a decision to make an investment
into Charles' education in the early years, rather than save for
College. When we started our programme, we employed Dr Felicity Adams,
(clinical psychologist) to be the programme manager and her role
included:

Interviewing staff

Training staff

Constructing and writing the programme

Meeting with me fortnightly and adapting the programme to Charles' needs

Monitoring the stress levels within the family and trying to keep a healthy balance

Viewing video footage and writing recommendations for staff

Support for me

Heading team meetings

Wage reviews

References and background information are essential. It is also
important to feel comfortable with the person, as you will be spending
many hours together and rely on each other to manage the team of
therapists and keep communication at it's best.

My Role - Obsessed? - Maybe (Just a Little)

Here are some helpful hints:

Put anything that is
desired by the child up high (out of reach) in see-through containers.
OBJECT: To encourage the child to point to or, request the item
depending on the stage he/she is at.

If the child can't stand
change - go the 'Full Monty' - change as much as possible as often as
possible to de-sensitise him/her. OBJECT: To accept change.

Pass on any books or
information on autism to anyone that spends time with your child. If
someone is with him/her they might as well use that time productively.
Have lists available of what your child is up to and what speech
he/she has mastered. OBJECT: This is an important step towards
generalising.

Have lists around the
house and readily available explaining what your child is capable of
and what you are working on. OBJECT: To maximise every learning
opportunity.

Always be on the look out
for interesting rewards and have suggestions ready for Christmas and
Birthday recommendations. OBJECT: To keep the sessions fun and
exciting.

Worried about going out
and what teaching time your missing out on? Use outings to generalise
and teach new skills (by using techniques that your child has already
mastered at home) out in the community. OBJECT: Generalisation.

Keep ahead of your child's
programme by having materials ready in advance. Don't hold him/her back
from learning because of lack of materials. OBJECT: To keep teaching
at the required level.

Video taping sessions is a
great way to ensure quality teaching time and ongoing support and
training for therapists. OBJECT: To make sure that, the structure of
the lessons, is followed through by everyone.

Look after your staff.
Everyone gets tired and bored in any occupation. When dealing with
children with autism, you can add pure frustration to the list and the
stress involved in dealing with people in a stressful environment
(having a child with a disability) is another major issue. OBJECT: To
keep a healthy, happy team to ensure the best outcomes for your child
and to avoid the stress of having to find 'new' staff.

I found having a private
and comfortable workroom, ensured that the therapists, also felt they
had privacy, and were comfortable. OBJECT: To enhance maximum learning
opportunities.

Know your child's programme.
To gain the maximum benefits of running a home programme you need to be
able to move with your child on a daily basis. The only way this is
possible is to read the notes on a nightly basis so that you can keep
up with the progress and adapt your own skills to meet your child's
needs. OBJECT: To keep teaching at the desired level.

Always look into
'Alternatives' with diet and other interventions. I recommend children
having allergy tests and a test for epilepsy, as both are common in
children with autism. OBJECT: To rule out any other problems.

Be one step ahead, all of
the time. Find your child's aide for school, before the school,
recommend someone. This is not an option that is always available but
it is worth a try! OBJECT: To give your child the chance in the most
important years of his/her life - school. If you have an understanding
with your child's aide on strategies it will make the world of
difference.

Get a camera! Take photos
of anything that is relevant to your child's world. Make up schedules,
timetables and explain outings with photos of what you are doing, who
you are seeing and where you are going. OBJECT: For him/her to 'see'
and therefore understand what we are saying. When the action is then
carried out, it is a great and natural reinforcement for the child.

Obsessions - AGH! - BUT
they can be useful. Use his/her obsessions to maximise learning
opportunities. For example: If you are teaching long/short and he/she
has an obsession with trains, use a train track to teach the
difference. OBJECT: If he/she is interested in the lesson there is a
much higher rate of success therefore maximising learning outcomes.

Financial Situation??? Use
the therapist's time for what they are employed to do, unless you can
afford otherwise. Set up the equipment, have notes prepared and a
clean room so that they can come in and do what they do best -
teaching your son/daughter. I preferred to clean and organise the room
rather than make up lost time with the lessons for Charles. OBJECT: To
maximise learning time.

I found using 'shoe boxes'
or labelled containers with the drill name clearly labelled helped
with organisation. OBJECT: Productive Sessions

Have a white board in the
workroom so that any concerns can be written up and dealt with
straight away. This is also an easy way for the therapists to
communicate. OBJECT: Keeping communication lines open.

Have a timetable set up
for the therapists to allow them access to the house without
interruptions from parents, siblings, visitors. OBJECT: To generalise
outside of the room without distractions.

A sturdy table and
comfortable chairs are essential. OBJECT: If the therapist and child
are comfortable they can get on with the 'job'.

Kindergarten and Pre-school Integration Tips

Note that although these notes are most relevant to Western Australian
residents, they will still be helpful to any parent who has a child with
autism.

Starting kindergarten, pre-school or school is a daunting task for any
parent. When you have a child with a disability it is even more so. The
following suggestions are a basic guideline only, written by me - a parent of
a child with autism - to try and help your journey into the school
years.

The first decision that needs to be made, is the type and style of schooling
that you think will be appropriate for your child. For example: Structured
routine or a flexible learning environment. In the kindergarten and
pre-school years it may be appropriate to send your child to the local
kindy/pre-primary and observe from there on, as to how they adjust. In
primary school years you may want to look further into the best available
options for your child.

These options include Educational Support Units/Centres/Schools, main stream
schooling with an aide, private education Catholic/Independent or home
schooling.

I often find parents would like their children to attend mainstream schools
with an aide as their first option but in my opinion it is also important to
look at the needs of the child and where they are best situated to achieve
maximum learning outcomes and social experiences.

I hope these notes are of some assistance to you and your child and please
don't hesitate to contact your Local Area Coordinator for further inquiries
in relation to what you are entitled to and your rights as a parent.

You may choose to send your child to kindergarten or pre-school for the
standard sessions, although another option you can choose, is to send
your child to only a few sessions per week. If this is the case, the
kindergarten or pre-school sessions can still be useful for
socialisation, conforming in a group situation and for learning.

The amount of time that YOU wish your child to attend is something
that YOU can discuss with the headmaster and the teacher involved
at the school of your choice. It is important to make an appointment
prior to the year your child will attend kindergarten or pre-primary,
with the headmaster and teacher, either separately, or together as a
group, to discuss the needs of your child.

You will need to notify the school involved that your child will be
attending the following year. If you are applying for a teacher aide
assistant, then you will need to meet with the headmaster early in term
3, of the previous year that your child is attending, to assist with
paperwork for the application of an aide. Ensure that YOU as a
parent are involved in the development of the aide application.

An aide and specific time slots are not guaranteed. It is always best to
emphasise your child's needs and vulnerability to achieve the maximum
aide time available. The most successful applications for aide time seem
to be those that include safety concerns and whether or not, the child is
toilet trained. I advise that these issues be thought out carefully when
filling in the application. Can your child pull up his zip and do his
buttons up? If not then he/she is not toilet trained (ie: independent in
his/her toilet skills). Does the school have locked gates? Is there a
main road nearby? Does he/she have road sense? If not who will assist
him/her on excursions? Does the child understand consequences of his/her
actions? What would the child do if someone took something from them in
the playground and there was no supervision? Would they retaliate by
hitting? These are all issues that no matter how painful to think about,
must be given thought to, as they will help your child, achieve maximum
aide time.

When the school sends in the application for aide time, attach any
documentation from speech therapists, psychologists or other
professionals that you can gather, in relation to your child's problem
areas and as to why they will need help.

If the amount of time allocated is not enough, then you can appeal but
you will need to state, in length, the reasons why. It is easier to apply
yourself to the first application to ensure your child receives the time
needed rather than lodge an appeal.

The teacher aide is usually employed through the Education Department. In
our case we advertised (through the local university) and sought our own
aides so they could be trained in Applied Behaviour Analysis (ABA). I
would offer the person to the school as an option and I was fortunate
enough, in both cases, for the headmaster to agree and support the
employment of the person that I recommended. Unfortunately this isn't a
method that it always available but it is worth a try. This is also
something that can be discussed at the pre-attendance meeting in the
previous year. My theory is, if you make it easier for the headmaster, by
supplying someone, then they will usually welcome the assistance and you
are both winners. It is important to have a good communication system
with the person that will act as an aide for your child. Finding someone
that you feel comfortable with, rather than being allocated someone, may
help when starting school.

If you feel your child is going to struggle with the routine of
kindergarten or pre-primary then it may be best to start the year with
only short attendances and gradually build the hours and days up as the
child adjusts to his/her new environment. This method will ensure a
better 'settling in' period as the time isn't built up until the child
has adjusted to the session times he/she is attending. If a child has a
strong dislike to attending in the early stages and is forced to endure
long and numerous days throughout the week, the child may build up a
resistance to him/her going, causing continuous problems throughout the
year. If the child enjoys the experience and looks forward to going, then
it will make kindergarten or preschool integration a lot easier for all
those involved.

When meeting with the teacher to discuss your child's needs it is also a
good idea to find out the routine of the kindy so that you can help your
child prepare for his/her new adventure. If they have morning or
afternoon tea, then you can start preparing snacks at home in glad wrap
and lunch boxes, that will be used at school. As there will be so much
for the child to take in, it will help if he/she has some familiar
objects around. It is also an opportunity to assist with any difficulties
opening lids and unwrapping etc. If they have their own cups or water
bottles to use at school then using it at home prior to starting school
will help the child recognise his/hers automatically and avoid confusion.

You may like to seek advice on setting up a picture or compic schedule
that will help your child understand their day. Teaching your child to be
able to read a schedule before they commence kindergarten will help if
you want to use a schedule when school commences. If you are unsure of
how to set up a schedule then you can contact your Local Area Coordinator
to access information on who may be able to help you with setting up a
schedule.

The assistance that you give to your child in preparation for
kindergarten and pre-primary will help with the transition period. It can
also help, to reassure the teacher that your support is available and
notify them of any other support networks that they can access if
problems arise. If the support network is set up before any problems
occur it will help provide you, the school and the teacher with a back

I think one of the most important factors in your child's start to school
is the relationship that you need to build up with the teacher aide,
teacher and headmaster. It can be a daunting task for school staff also
and if they know they have support, it will help reassure them that they
can access assistance if it is needed.

A communication book is a great idea to stay in touch with your child's
day. Any problem areas can be raised through the book without the teacher
approaching you in front of other parents and children at pick up time.

The communication book can also be used to note songs the children will
be learning etc. so they can be practised at home. Having a cassette made
up, of the songs that the children will be learning, can help your child
learn the words - making it easier for him/her to interact at music time.
The cassette can be played at home or in the car. The teacher may be
willing to organise this for you or you may need to tape the songs
yourself.

The communication book is also handy for noting anything of importance at
kindergarten, pre-primary or at home. You can make up your own
communication sheets and place them in a file, detailing what you would
like to know. For example:

The communication book is also handy for noting anything of importance at
kindergarten, pre-primary or at home. You can make up your own
communication sheets and place them in a file, detailing what you would
like to know. For example:

Date:
Attended when name called:
Mat Time:
Playtime:
Social Interaction:

This is just a very basic example of a communication sheet you may like
to use. The sheet I use then has numbers from 1 - 5 (5 being excellent,
down to 1 being poor effort). The aide puts a circle around the
appropriate number and then adds any relevant notes. This is done on a
daily basis and if the aide has some guidelines then it helps them to
know what to comment on. The subjects can be changed as the child moves
on to more difficult challenges. For example:

Once again this is just a very basic example. I feel it is important for
teacher aides/assistants to have guidelines to follow and some structure
and goals for the day.

If your child has a language/comprehension deficit then making a book at
the beginning of the year with photos of class members and teachers can
help. Once again the teacher may be prepared to take the photos for you
but if not, you will have to take them yourself. One photo per page with
the child's first name written underneath is all that is needed. The book
can be looked through before going to bed each night or you may choose to
work on one child at a time or focus on the children that your child has
befriended. When your child needs help it is easier if they can approach
other children by their name rather than tugging at their clothing etc.

Most kindergartens and pre-primary centres have a meeting at the
beginning of the term for parents to meet one another and for the teacher
to discuss what the children will be doing throughout the year. This can
be an excellent opportunity to inform other parents in the class about
your child and their disability. I found the first time I did this I was
quite nervous but it was worth the effort as people were generally
interested in how they could help. Some parents raised questions such as
would he be able to attend birthday parties etc? How should they
communicate with him when they are on roster? Did I want him to have
special attention or be treated the same as the other children? Speaking
out at the beginning of the year can limit gossip and misunderstandings
and I would recommend doing so to any parent. If you don't feel up to
standing up in front of other parents, then you may like to prepare
something for the teacher to read out. I feel talking about your child's
disability can help people understand your child and his/her difficulties
and see him/her for the person they are.

Try and stay positive in difficult circumstances and look at the problem
at hand. It is important to focus on 'what needs to be done' and how you
can achieve that goal rather than get caught up in the emotional side of
the problem. This sounds easier than it is to put into practice but if
you, as the parent, stay positive and help in difficult situations, it
will also provide the teacher and headmaster with the support they need.
Keep communication lines open with all parties involved and be open to
suggestions.